|Prognostic value of systemic endothelial dysfunction in patients with acute coronary syndromes: further evidence for the existence of the "vulnerable" patient.|
|PMID: 15451794 Owner: NLM Status: MEDLINE|
|BACKGROUND: Endothelial vasodilator dysfunction may serve as a marker integrating the vascular risk of an individual; however, whether systemic vasodilator function predicts disease progression and cardiovascular event rates in patients with manifest acute coronary syndromes (ACS) is unknown. METHODS AND RESULTS: In 198 patients with angiographically documented ACS, forearm blood flow (FBF) responses to acetylcholine (ACH; 10 to 50 microg/min) and sodium nitroprusside (SNP; 2 to 8 microg/min) were measured by venous occlusion plethysmography before hospital discharge within 5 days of an episode of an ACS. Cardiovascular events (cardiovascular death, myocardial infarction, and ischemic stroke) served as outcome variables over a mean follow-up period of 47.7+/-15.1 months. Patients who experienced cardiovascular events during follow-up (n=31) had a significantly reduced vasodilator response to ACH (P<0.05) and SNP (P<0.05). By multivariate analysis, vasodilator response to ACH and elevated troponin T serum levels were the only significant (P<0.05) independent predictors of a poor prognosis, even after adjustment for traditional cardiovascular risk factors, concurrent medication, invasive treatment strategy, and C-reactive protein serum levels. Recovery of endothelium-dependent vasoreactivity as assessed by repeated FBF assessment 8 weeks after the index measurement after the ACS predicted further event-free survival in a subset of 78 patients. CONCLUSIONS: Systemic endothelium-dependent vasoreactivity predicts recurrence of instability and cardiovascular event rates in patients with ACS. Furthermore, the recovery of systemic endothelial function is associated with event-free survival. Assessment of systemic vasoreactivity, measured by a minimally invasive test, provides important prognostic information in addition to that derived from traditional risk factor assessment in patients with ACS.|
|Stephan Fichtlscherer; Susanne Breuer; Andreas M Zeiher|
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|Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2004-09-27|
|Title: Circulation Volume: 110 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2004 Oct|
|Created Date: 2004-10-06 Completed Date: 2005-05-27 Revised Date: 2006-11-15|
Medline Journal Info:
|Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States|
|Languages: eng Pagination: 1926-32 Citation Subset: AIM; IM|
|Department of Internal Medicine IV, Division of Cardiology, Johann W. Goethe University, Theodor Stern Kai 7, D-60590 Frankfurt, Germany. firstname.lastname@example.org.|
|APA/MLA Format Download EndNote Download BibTex|
Brain Ischemia / epidemiology
C-Reactive Protein / analysis
Endothelium, Vascular / drug effects, physiopathology*
Forearm / blood supply
Myocardial Infarction / epidemiology
Myocardial Ischemia / blood, mortality, physiopathology*
Nitroprusside / diagnostic use*
Predictive Value of Tests
Troponin T / blood
Vasculitis / blood, complications, physiopathology
Vasodilation / drug effects*
Vasodilator Agents / diagnostic use*
|0/Biological Markers; 0/Troponin T; 0/Vasodilator Agents; 15078-28-1/Nitroprusside; 51-84-3/Acetylcholine; 9007-41-4/C-Reactive Protein|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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